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Name and Address of Person Sending Package Name This Authorization Is Not Valid After The Date Shown. Address City Enter Inmate Name, Register No., and Institution Address Here: State Zip Code THE NAMED INMATE IS AUTHORIZED TO RECEIVE (specify below): You are authorized to send the following personal property. PLEASE NOTE: Including unauthorized materials in the package will result in the entire package being returned undelivered. QUANTITY ITEM AND DESCRIPTION (INCLUDED STATED VALUE).

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